Introduction We believe that a combination of cheilectomy and proximal phalangeal osteotomy can be used successfully (with an 85% satisfaction rate1) in patients with advanced hallux rigidus, including those in whom it is classified as Hattrup and Johnson2 Grade III or as Coughlin and Shurnas3 Grade III or IV (extensive degeneration of the joint involving >50% of the articular surface).

Step 1: Surgical Approach Begin with a dorsal approach to the first metatarsophalangeal joint and phalanx.

Step 2: Cheilectomy Remove osteophytes and the dorsal third of the first metatarsal head.

Step 3: Proximal Phalangeal Osteotomy Perform a 3-mm dorsal-based closing-wedge osteotomy of the proximal phalanx.

Step 4: Closure and Postoperative Protocol Close the metatarsophalangeal joint capsule and skin.

Results We reviewed the results in eighty-one patients with advanced hallux rigidus who were treated with a combination of cheilectomy and proximal phalangeal osteotomy.

What to Watch For Indications